Printed from chabadsj.com
 

Memorial Plaque Board

Memorial Plaque Board

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 Located in Chabad of S. Jose is a most beautiful and elegant Memorial Board

with the design of the tree of life its theme.

To have a relative or friend inscribed on the Memorial Plaque Board  please fill out the form below.

DONOR INFORMATION (individual ordering the plaque)
First name   State
Last name   Zip
Address   Email
City   Phone
 
DEDICATION PLAQUE 
I would like to dedicate  plaque/s at $540.00 per name/plaque.
Please inscribe the following name on the memorial tablet:
PLAQUE #1   PLAQUE #2
Last Name   Last Name
First Name   First Name
Hebrew Name   Hebrew Name
Fathers Hebrew Name   Fathers Hebrew Name
Date of Passing
mm/dd/yy
  Date of Passing
mm/dd/yy
After dark? Yes No   After dark? Yes No
 
 
PAYMENT DETAILS
I am dedicating a plaque: 
 My credit card will be charged once, upon completion of the form below, in the amount of $500 

Name on card   Amount to be charged TODAY
Card Number   Card Type
Exp. Date     CVV Code  3 digits on back of card

 

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